Chapter 24 - Preventive antibiotics in surgery

Summary

Introduction

In 1867, British surgeon Joseph Lister published his landmark series On the Antiseptic Principle of the Practice of Surgery in which he presented his novel technique of applying carbolic acid on surgical wounds to destroy “septic germs” [1]. This “aseptic” technique markedly decreased the incidence of gangrene and death and helped solidify the belief that “minute organisms” were the cause of suppuration. Rapid progress in aseptic technique followed and, coupled with the discovery of antibiotics such as penicillin in the mid-1900s, revolutionized the field of surgery from a practice that had been plagued by frequent infection and death into the discipline it is today. Yet, despite more than a century of great improvements in the prevention of surgical site infections (SSIs) and antimicrobial prophylaxis, surgery-related infections remain a problem.

Over 30 million operative procedures are performed in US hospitals each year, with an overall postsurgical infection rate of 2–5% [2,3]. Among healthcare-associated infections, surgical site infections (SSIs) are the second most common, accounting for 17–20% of all nosocomial infections [2,4]. The US Centers for Disease Control and Prevention (CDC) reports that about 500,000 SSIs occur yearly, but this number is likely an underestimation of the true burden. This underestimation probably can be attributed to the rapid proliferation of outpatient/ambulatory surgeries and shorter postoperative inpatient days, which, in turn, have made the detection of SSIs more difficult. In fact, outpatient operations accounted for 63% of all surgeries performed in US community hospitals in 2002, compared with just 16% in 1980 [5]. In 2006, an estimated 53.3 million surgical and non-surgical procedures were performed in ambulatory surgery centers, yet there is no standardized method for SSI surveillance in these venues [2,6]. Globally, the lack of surveillance systems for SSIs in developing countries makes it difficult to gauge the worldwide burden of SSIs. However, in their meta-analysis of 220 studies of healthcare-associated infections in developing countries, Allegranzi and colleagues estimate that SSIs are the leading cause of nosocomial infections with an incidence up to three times higher than that recorded in developed countries [7].